Build Dakota Scholarship Acceptance Agreement Build Dakota Scholarship Offer Status (please mark one) DATE: Thank you I will accept the Build Dakota Scholarship. Please complete this packet in its entirety and return it within 3 weeks from the date above. No, Thank you - I do not wish to accept this award. Signature: : If you are not accepting this award, please simply sign and date above, and return the remainder of this packet uncompleted. I,, understand that a technical education scholarship has been awarded to me so that I may enroll in and complete the program at. This program is designed to prepare me for employment in a high-need occupation in South Dakota. The award of this scholarship is in an amount to cover my tuition, fees, program expenses and required equipment, tools and/or technology to complete the program stated above. If I accept an additional scholarship from a South Dakota business or industry as part of my Build Dakota Scholarship package, that scholarship will be listed below and the amount of my Build Dakota Scholarship will be adjusted so the two awards cover the expenses described above. Any scholarship and/or employment commitments I have made with a South Dakota business or industry are defined in an agreement outside of this agreement. I will begin the program in and complete the program, on schedule, in. Accepting this scholarship means that I agree to the following terms (please read and HAND INITIAL that you have read and understand the terms): 1. I will enroll full-time in the program stated above. 2. I will complete the program in the expected time. 3. I will maintain at least a 2.5 cumulative grade point average (GPA) throughout my enrollment in the program. 4. I will satisfactorily meet all graduation requirements for the program stated above in the time expected to complete the program. 5. If I fail to meet the grade requirement in any course in the program stated above, I will re-take the course. The amount of my Build Dakota Scholarship will not be increased to do so. 6. I may be required to submit to drug tests or background checks and must clear those with satisfactory results. 7. I will immediately repay any scholarship proceeds that cannot be attributed to educational expenses for attendance on a full-time basis. 8. I agree to allow the Build Dakota Scholarship Administration Board or its agents to obtain enrollment and contact information from any of the officers or agents of the technical institute at which I become enrolled, am enrolled or was enrolled. 9. I will live and work full-time in South Dakota, in my field of study, for 36 months following graduation. I have up to 6 months following graduation to secure a job in my field of study. If I do not begin full-time employment in that field immediately following graduation, my 36 month employment commitment will begin as soon as I secure a job in the field. STUDENT: Please initial here: (page 1 of 4 total pages) 10. I will notify my future employer(s) of my participation in the Build Dakota Scholarship program and the employment commitment I have made.
11. I will provide the necessary evidence to the Build Dakota Scholarship Administration Board or its agents 12, 24 and 36 months following the start of my full-time employment to document my compliance with the program requirements. 12. I agree to allow my future employer(s) to provide employment verification to the Build Dakota Scholarship Administration Board or its agents throughout my employment commitment. 13. I may request to defer my employment obligation in order to pursue further education in my field of study. Requests for educational deferment must be made to the Build Dakota Scholarship Administration Board within 3 months of graduation from my scholarship-supported program. I understand that the Build Dakota Scholarship Administration Board may approve a deferment period suitable for the degree I am seeking and will require regular reporting on the progress of my education. I understand the Build Dakota Scholarship Administration Board may terminate my deferment period if I am not making suitable progress towards on-time completion. My employment commitment will begin immediately following the completion of my continuing education. I agree to allow my future education provider to provide enrollment and contact information to the Build Dakota Scholarship Administration Board or its agents throughout my enrollment. 14. While enrolled in the program stated above, I will inform the technical institute at which I accept a Build Dakota Scholarship within ten days of any changes affecting my enrollment status, name, address or other contact information. 15. Following graduation, I will inform the Build Dakota Scholarship Administration Board or its agents within ten days of any changes affecting my employment status, name, address or other contact information. The technical institute at which I accept a Build Dakota Scholarship may terminate my scholarship award in line with its behavior and conduct policies for any of the following circumstances, including but not limited to (please read and HAND INITIAL that you have read and understand each statement): 1. I am repeatedly tardy or absent, exhibit a poor attitude, or consistently demonstrate a lack of work ethic. 2. I violate any criminal statute of moral turpitude. 3. I commit a serious act of misconduct such as dishonesty, plagiarism, theft, assault or abuse. 4. I am convicted of any charge that would be cause for termination if employed in my field of study. 5. I commit an act which might bring disrepute to or reflect unfavorably upon the technical institute at which I am enrolled, the Build Dakota Scholarship program or any business I work at or complete an internship with. If I fail to meet any of the above terms or circumstances prior to graduation, it may be cause for termination of my Build Dakota Scholarship upon review by the technical institute president, under the direction of the Build Dakota Scholarship Administration Board. If I fail to meet the above terms following graduation, it may be cause for termination of my Build Dakota Scholarship upon review by the Build Dakota Scholarship Administration Board. If it is terminated, the scholarship will convert to an interest-bearing loan and I must pay back the scholarship, applicable interest, collection costs and attorney fees, or a prorated portion of them. I will be provided with the terms, conditions and repayment schedule of the loan at the time of termination. Appeals for extenuating circumstances will be taken to the Build Dakota Scholarship Administration Board. STUDENT: Please initial here: (page 2 of 4 total pages) I agree that in the event I fail to meet the terms or circumstances listed above, I will no longer be eligible for additional Build Dakota Scholarship funds.
I understand that I may cancel this scholarship while I am a full-time student by repaying all proceeds that were issued for my benefit, provided that all of the proceeds are repaid prior to the end of the semester in which the decision to cancel the scholarship is made. If I am unable to repay the funds prior to the end of the semester in which the decision to cancel the scholarship is made, the scholarship will convert to an interest-bearing loan and I must pay back the scholarship, applicable interest, collection costs and attorney fees for the portion of the scholarship I received, to date. Appeals for extenuating circumstances will be taken to the Build Dakota Scholarship Administration Board. I authorize the Governor of South Dakota, the Build Dakota Scholarship Administration Board or its agents and the technical institute at which I have accepted the scholarship to publically release my name, school (if applicable) and city when announcing the Build Dakota Scholarship recipients. I authorize the Build Dakota Scholarship Administration Board or its agents to release information pertinent to this scholarship to the references listed below, my future employers and to members of my immediate family. In signing this agreement, I accept that it is fair and binding. I understand and accept all of the terms and conditions of the agreement and will adhere to them. The authorizations I have made will stand throughout my education and employment commitment. If I choose to alter any authorization, I must provide directions for change in writing to the Build Dakota Scholarship Administration Board. Under penalty of perjury, I certify that the information I have provided on the Build Dakota Scholarship Acceptance Agreement is true, complete, and accurate to the best of my knowledge. Signature of Build Dakota Scholar Parent/Guardian Signature, if Scholar is under the age of 18 Recipient Information The information provided on this Acceptance Agreement will be shared and released as authorized in the agreement, including verifying education and employment records. The scholarship recipient s Social Security Number may be used as an account identifier. Should the scholarship convert into an interest-bearing loan, this information will be used in the servicing and collection of that loan. Please make any correction necessary on any pre-filled areas (obtained from your scholarship application), and complete fully the remaining areas: 1. Last Name: First Name: Middle Initial: 2. Social Security #: Permanent Street Address: 3. Telephone Number: 4. of Birth 5. Driver s License State and Number 6. State: #: STUDENT: Please initial here: (page 3 of 4 total pages)
7. Reference 1: Name: Permanent Address: Reference 2: Name: Permanent Address: Reference 3: Name: Permanent Address: Please list any South Dakota Business/Industry Scholarship Awards here (if not applicable, indicate N/A): STUDENT: Please initial here: (page 4 of 4 total pages) ++++OFFICIAL USE ONLY+++++++++++++++++++++++++++++++++++++++++++++++
Technical Institute: Eligible Program: Required Enrollment : Required Completion : Certificate or Degree: EST. Amt of BDS: EST. Start -Employment EST. End -Employment Technical Institute President Build Dakota Program Manager Notes Regarding Build Dakota Scholar Success, Appeals, Termination, Employment, etc.:(area for staff to enter notes )